The measles-mumps-rubella (MMR) vaccine is a live-attenuated combined vaccine employed to combat infectious diseases (measles, rubella and mumps). It is also indicated in distinctive patient populations as post-exposure prophylaxis (PEP) to rubella, mumps, and/or measles.
Indications for the measles-mumps-rubella (MMR) vaccine
Measles-containing vaccines are suggested for the routine immunisation of children and adolescents who have not been immunised on a regular program.
It is also indicated for adults born after 1970 (who have not received immunisation).
Adults born before 1970 can be considered to possess natural immunity to measles; still, military personnel, healthcare workers, and susceptible travellers should receive the MMR vaccine.
Women should be vaccinated before or during their reproductive years because rubella can lead to congenital malformations in the foetus.
Non-immunised female patients willing to become pregnant must be vaccinated with the MMR vaccine in no <1 month before becoming pregnant.
Pregnant women might be administered the MMR vaccine in measles or rubella outbreaks as the benefits of vaccination outweigh the risks.
The MMR vaccine must be administered after delivery to non-immunised patients, as it is safe during breastfeeding.
MMR vaccine can be given as PEP to the following individuals:
Patients between 6-12 months old who are immunocompetent and have had an exposure in the last 72 hours and non-pregnant women 12 months or older who are immunocompetent with exposure in the previous 6 days.
Individuals <six months, between 6-12 months, and who have suffered exposure >72 hours ago, pregnant, or immunocompromised must receive an immunoglobin preparation for PEP
A: Autism spectrum disorders (ASD) are a group of complex brain development disorders. This umbrella term covers conditions such as autism and Asperger syndrome. These disorders are characterized by difficulties in social interaction and communication and a restricted and repetitive repertoire of interests and activities.
Q: How common are autism spectrum disorders?
A: Reviews estimate that 1 child in 160 has an autism spectrum disorder. This estimate represents an average figure, and reported prevalence varies substantially across studies. Some recent studies have, however, reported rates that are substantially higher.
Q: Do people with an autism spectrum disorder always suffer from intellectual disability?
A: The level of intellectual functioning is extremely variable in persons with an autism spectrum disorder, ranging from profound impairment to superior non-verbal cognitive skills. It is estimated that around 50% of persons with ASD also suffer from an intellectual disability.
Q: How early can an autism spectrum disorder be recognized in children?
A: Identifying an autism spectrum disorder is difficult before the age of about 12 months but diagnosis is generally possible by the age of 2 years. Characteristic features of the onset include delay in the development or temporary regression in language and social skills and repetitive stereotyped patterns of behaviour.
Q: What can parents do to help their child with an autism spectrum disorder?
A: Parents have an essential role in providing support to a child with an autism spectrum disorder. They can help to ensure access to health services and education, and offer nurturing and stimulating environments as their child grows up. Recently, it has been shown that parents can also help deliver psychosocial and behavioural treatments to their own children.
Q: What causes autism spectrum disorders?
A: Scientific evidence suggests that various factors, both genetic and environmental, contribute to the onset of autism spectrum disorders by influencing early brain development.
Q: Are childhood vaccines responsible for autism spectrum disorders?
A: Available epidemiological data show that there is no evidence of a link between measles-mumps-rubella (MMR) vaccine and autism spectrum disorders. Previous studies suggesting a causal link were found to be seriously flawed.
There is also no evidence to suggest that any other childhood vaccine may increase the risk of autism spectrum disorders. In addition, evidence reviews commissioned by WHO concluded that there was no association between the use of vaccine preservatives such as thiomersal and autism spectrum disorders.
Measles is spreading across Europe wherever immunisation coverage has dropped, the World Health Organization is warning.
The largest outbreaks are being seen in Italy and Romania.
In the first month of this year, Italy reported more than 200 cases. Romania has reported more than 3,400 cases and 17 deaths since January 2016.
Measles is highly contagious. Travel patterns mean no person or country is beyond its reach, says the WHO.
For good protection, it’s recommended that at least 95% of the population is vaccinated against the disease.
But many countries are struggling to achieve that.
Most of the measles cases have been found in countries where immunisation has dipped below this threshold and the infection is endemic – France, Germany, Italy, Poland, Romania, Switzerland and Ukraine.
Preliminary information for February suggests that the number of new infections is rising sharply, says the WHO.
WHO regional director for Europe Dr Zsuzsanna Jakab said: “I urge all endemic countries to take urgent measures to stop transmission of measles within their borders, and all countries that have already achieved this to keep up their guard and sustain high immunisation coverage.”
The European Centre for Disease Prevention and Control says that between 1 February 2016 and 31 January 2017 the UK reported 575 cases of measles.
The MMR (measles, mumps and rubella) vaccine is available on the NHS for babies and pre-school children.
Lagging immunisation
Robb Butler, of the WHO Regional Office for Europe, says there are a number of reasons why vaccination coverage has waned in some regions.
“In some countries, like the Ukraine, there have been supply and procurement issues.”
Then there’s vaccine hesitancy. Some people are fearful of vaccination, while others are complacent or find it an inconvenience, he says.
In France, for example, people need to make an appointment with their doctor to get a prescription, go to the pharmacy to collect the vaccine and then rebook with their doctor to have the jab administered.
“We need to get to the point where we appreciate that people have busy lives and competing priorities.”
Dr Mary Ramsay, Head of Immunisation at Public Health England, said: “England’s uptake of MMR vaccine by five years of age has reached the WHO’s target of 95%.
“In the last year, the measles cases confirmed in England have mainly been in older adolescents and young adults with many linked to music festivals and other large public events. Individuals of any age who have not received two doses of the MMR vaccine, or those who are unsure, should speak to their GP – it’s never too late to have the vaccine and measles can still be serious in adults. We are continuing to invest in programmes which encourage uptake of the vaccine to ultimately consign measles to the history books.”
Measles
Unvaccinated young children are at highest risk of measles and its complications, including death
Measles is spread by direct contact and through the air by coughs and sneezes
The virus remains active and contagious on infected surfaces for up to two hours
The first signs of infection are usually a high fever and cold-like symptoms, such as a runny nose
You may notice small white spots on the inside of the cheeks as well
After several days, a rash develops, usually on the face and neck first and then spreading to the body and limbs
An infected person can pass on the virus to others from four days prior to developing the skin rash to four days after the rash erupts
There is no treatment, but two doses of vaccine can prevent infection in the first place
Children with juvenile idiopathic arthritis who’ve undergone primary vaccination for measles, mumps, and rubella (MMR) do not risk an increase in arthritis activity after revaccination with a live attenuated booster, according to a JAMA study.
Researchers in the Netherlands randomized 130 patients to receive either booster vaccination or no revaccination; the children, aged 4 to 9, were followed for 1 year. (Those receiving biologic therapies, such as the tumor necrosis factor antagonist etanercept, suspended those treatments around the time of the booster.)
At 1 year, measures of arthritis disease activity did not differ significantly between the groups. In addition, children receiving the booster had higher antibody concentrations against MMR than did the controls.
The authors caution that few of the children were taking biologics, and more data would be needed to reassure safety in those cases. Also, they emphasize that the patients primarily had low disease activity.
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